Optimizing Lung Cancer Screening in Cancer Survivors

优化癌症幸存者的肺癌筛查

基本信息

批准号：
10654616
负责人：
Chung Yin Kong
金额：
$ 67.2万
依托单位：
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-07-15 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10654616
关键词：
Age Biochemical Breast Calibration Cancer Etiology Cancer Model Cancer Survivor Clinical Trials Colorectal Colorectal Cancer Data Decision Making Detection Development Diagnosis Disease Eligibility Determination Ethnic Origin Exclusion Female Frequencies General Population Goals Health Care Costs Malignant Neoplasms Malignant neoplasm of lung Methods Modeling Outcome Patient-Focused Outcomes Patients Population Population Heterogeneity Populations at Risk Preventive service Prostate Quality of life Race Radiation therapy Recommendation Recording of previous events Recurrence Regimen Risk Screening for cancer Second Primary Cancers Smoking Smoking History Survivors Time Tobacco use Treatment Side Effects United States Woman cancer diagnosis cohort colorectal cancer screening comorbidity cost effectiveness effectiveness evaluation ethnic diversity high risk human old age (65+)innovation lung cancer screening men models and simulation mortality mortality risk multi-ethnic multi-racial novel population based racial diversity randomized trial screening screening guidelines sex survivorship tobacco exposure

项目摘要

The goal of the proposal is to identify optimal lung cancer (LC) screening strategies for breast (BC), prostate (PC), colorectal (CRC) cancer survivors. We will accomplish these goals by developing and validating a novel Multi-Racial and Ethnic Lung Cancer Model (MELCAM) that will simulate LC development, progression, screening, treatment, and survival in a multiethnic cancer survivor population. We will then assess the effectiveness and cost-effectiveness (CE) of different LC screening strategies for these survivors. All together, there are >6 million BC, CRC and PC survivors in the US, and as these cancers tend to be diagnosed in early stage, many survivors live for a long time and develop and may die from second cancers. Cancer survivors are also at increased risk of developing LC due to relatively high rates of smoking (up to 50-60%), age, and treatment-related side effects. As a result, >15% of LC are diagnosed in cancer survivors, and LC is the top cause of cancer-related mortality in this population. Little is known about optimal LC screening for cancer survivors who have been excluded from prior randomized trials (RCT) and have a different harm/benefit ratio from screening due to competing risk of death from their first cancer and higher burden of comorbidities. Lack of data to guide decisions about LC screening in cancer survivors has profound negative impact on survivorship, including under and overuse of LC screening, resulting in worse outcomes and increased healthcare costs. It is unlikely that RCT assessing the benefits of LC screening for cancer survivors will ever be conducted. Thus, there is an urgent need to use alternative methods to determine the optimal screening strategy for these patients. In this study, we propose using simulation modeling, an approach complementary to RCTs, to assess the harms and benefits of LC screening in cancer survivors. The Specific Aims are to: (1) Derive and validate a model (MELCAM), based on a well-established framework, to simulate LC screening in BC, PC and CRC cancer survivors from diverse racial and ethnic backgrounds; (2) Determine the most effective and CE strategies for LC screening in BC survivors; (3) Identify the optimal LC screening strategies in PC survivors and determine their CE; and (4) Evaluate the effectiveness and CE of LC screening for CRC survivors. To achieve these Aims, we will use data from several large, representative, population-based cancer cohorts and robust harmonization methods to develop, calibrate, and validate MELCAM by incorporating the development, screening, work-up, treatment and survival of LC in multiethnic survivors of BC, PC and CRC (Aim 1). We will then use the model to simulate RCTs evaluating the effectiveness (in terms of maximizing survival, quality of life, and other patient-centered outcomes) and CE of LC screening regimens (eligibility, frequency and duration) in these cancer survivors (Aims 2-4). The study will be innovative in applying state-of- the-art modeling approaches to evaluate LC screening in a diverse population of cancer survivors, and results will have direct implications for the management of a large group of survivors.

该提案的目标是确定乳腺癌 (BC)、前列腺癌的最佳肺癌 (LC) 筛查策略 (PC)、结直肠癌 (CRC) 癌症幸存者。我们将通过开发和验证小说来实现这些目标多种族和民族肺癌模型 (MELCAM) 将模拟 LC 的发展、进展、多种族癌症幸存者群体的筛查、治疗和生存。然后我们将评估针对这些幸存者的不同 LC 筛查策略的有效性和成本效益 (CE)。所有人在一起，美国有超过 600 万 BC、CRC 和 PC 幸存者，而且这些癌症往往在早期就被诊断出来在这个阶段，许多幸存者存活了很长一段时间，并可能死于第二种癌症。癌症幸存者是由于相对较高的吸烟率（高达 50-60%）、年龄和吸烟率，患 LC 的风险也增加治疗相关的副作用。因此，>15% 的 LC 在癌症幸存者中被诊断出来，并且 LC 是最常见的该人群中癌症相关死亡的原因。对于癌症的最佳 LC 筛查知之甚少已被排除在之前的随机试验 (RCT) 之外且具有不同危害/获益比的幸存者由于首次癌症死亡的竞争风险和较高的合并症负担而无法进行筛查。缺少指导癌症幸存者 LC 筛查决策的数据对癌症幸存者产生深远的负面影响生存率，包括 LC 筛查使用不足和过度使用，导致结果更差并增加医疗费用。评估 LC 筛查对癌症幸存者的益处的 RCT 不太可能实施。因此，迫切需要使用替代方法来确定最佳筛选针对这些患者的策略。在本研究中，我们建议使用模拟建模，这是一种补充方法随机对照试验，评估 LC 筛查对癌症幸存者的危害和益处。具体目标是： (1) 基于完善的框架推导并验证模型 (MELCAM)，以模拟 LC 筛选来自不同种族和民族背景的 BC、PC 和 CRC 癌症幸存者； (2)确定最对 BC 幸存者进行 LC 筛查的有效和 CE 策略； (3) 确定最佳的 LC 筛选策略 PC幸存者并确定他们的CE； (4) 评估 LC 筛查 CRC 的有效性和 CE 幸存者。为了实现这些目标，我们将使用来自几个大型、有代表性、基于人群的癌症的数据队列和强大的协调方法，通过整合来开发、校准和验证 MELCAM BC、PC 和 CRC 多种族幸存者中 LC 的发展、筛查、检查、治疗和生存（目标 1）。然后，我们将使用该模型来模拟评估有效性的随机对照试验（就最大化生存率、生活质量和其他以患者为中心的结果）和 LC 筛查方案的 CE（资格、频率和持续时间）在这些癌症幸存者中（目标 2-4）。该研究将在应用现状方面具有创新性用于评估不同癌症幸存者群体的 LC 筛查的最先进的建模方法及其结果将对大量幸存者的管理产生直接影响。

项目成果

期刊论文数量（2）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Clinical and sociodemographic risk factors associated with the development of second primary cancers among postmenopausal breast cancer survivors.

与绝经后乳腺癌幸存者中第二原发癌症发生相关的临床和社会人口学危险因素。

DOI：
发表时间：
2023-03
期刊：
影响因子：
0
作者：
Bailey, Stacyann;Ezratty, Charlotte;Mhango, Grace;Lin, Jenny J
通讯作者：
Lin, Jenny J

A Cross-Sectional Analysis of the Lung Cancer Screening Eligibility Among Cancer Survivors Who Ever Smoked.

曾经吸烟的癌症幸存者中肺癌筛查资格的横断面分析。

DOI：
发表时间：
2024-02-06
期刊：
影响因子：
5.7
作者：
Wang, Qian;Hsu, Melinda L;Lin, Jenny J;Wisnivesky, Juan;Cullen, Jennifer;Dowlati, Afshin;Kong, Chung Yin
通讯作者：
Kong, Chung Yin